Three-Year long-term outcome of 458 naturalistically treated inpatients with 
major depressive episode: severe relapse rates and risk factors

Seemueller, Florian; Meier, Sebastian; Obermeier, Michael; Musil, Richard; Bauer, Michael; Adli, Mazda; Kronmueller, Klaus; Holsboer, Florian; Brieger, Peter; Laux, Gerd; Bender, Wolfram; Heuser, Isabella; Zeiler, Joachim; Gaebel, Wolfgang; Riedel, Michael; Falkai, Peter; Moeller, Hans-Juergen

doi:10.1007/s00406-014-0495-7

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Three-Year long-term outcome of 458 naturalistically treated inpatients with major depressive episode: severe relapse rates and risk factors

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Holsboer, Florian
Clinical Research, Max Planck Institute of Psychiatry, Max Planck Society;

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Citation

Seemueller, F., Meier, S., Obermeier, M., Musil, R., Bauer, M., Adli, M., et al. (2014). Three-Year long-term outcome of 458 naturalistically treated inpatients with major depressive episode: severe relapse rates and risk factors. EUROPEAN ARCHIVES OF PSYCHIATRY AND CLINICAL NEUROSCIENCE, 264(7), 567-575. doi:10.1007/s00406-014-0495-7.

Cite as: https://hdl.handle.net/11858/00-001M-0000-0024-53B5-9

Abstract

In randomized controlled trials, maintenance treatment for relapse prevention has been proven to be efficacious in patients responding in acute treatment, its efficacy in long-term outcome in "real-world patients" has yet to be proven. Three-year long-term data from a large naturalistic multisite follow-up were presented. Severe relapse was defined as suicide, severe suicide attempt, or rehospitalization. Next to relapse rates, possible risk factors including antidepressant medication were identified using univariate generalized log-rank tests and multivariate Cox proportional hazards model for time to severe relapse. Overall data of 458 patients were available for analysis. Of all patients, 155 (33.6 %) experienced at least one severe relapse during the 3-year follow-up. The following variables were associated with a shorter time to a severe relapse in univariate and multivariate analyses: multiple hospitalizations, presence of avoidant personality disorder, continuing antipsychotic medication, and no further antidepressant treatment. In comparison with other studies, the observed rate of severe relapse during 3-year period is rather low. This is one of the first reports demonstrating a beneficial effect of long-term antidepressant medication on severe relapse rates in naturalistic patients. Concomitant antipsychotic medication may be a proxy marker for treatment resistant and psychotic depression.